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Final Surgery Imp Questions > Basic > Flashcards

Basic Flashcards

1
Q

Mention risk factors for DVT

A

Prolonged immobilisation
Pelvic or lower limb orthopedic surgery
Obesity
Family history of thrombosis
Dehydration

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2
Q

Mention 4 Operative RFs for wound dehiscence

A

Vertical incision
Muscle cutting
Non absorbable sutures
Closure under tention
Drain inserted at the site of wound

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3
Q

Enumerate 4 causes of non infectious post operative fever

A

DVT
Lung atelectasis
Wound hematoma
Surgical trauma
transfusion reaction
Pyrogenic reaction to drugs

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4
Q

Causes of postoperative fever that require immediate intervention

A

Bowl leakage
PE
Surgical infections that causes myonecrosis
Malignant hyperthermia
Acute adrenal insufficiency

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5
Q

Causes of postoperative dyspnea

A

Lung atelectasis
PE
Myocardial infarction,HF
Pneumonia
Huge ventral hernia repair
EXACERBATION OF asthma and COPD

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6
Q

4 ttt option for necrotizing facilities

A

Aggressive surgical debridement
Systemic antibiotics
Iv fluids,good nutrition
Control blood glucose in DM

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7
Q

causes and RFs for nosocomial infections

A

Decrease host defence by surgical assault
Decrease general resistance dt malnutrition or malignancy
Prolonged hospital stay
Disruption of normal physiological barriers

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8
Q

4 predisposing factors for ssi

A

Wound hematoma
Foreign body
Chronic disease
Dm malnutrition obesity
Improper sterilisation of surgical equipments

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9
Q

Ttt of gas gangrene

A

Massive debridement
Iv fluids and systemic antibiotics benzylpenicillin
Hyperbaric oxygen

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10
Q

Principles of ttt of hand infection

A

Hand should be elevated to reduce pain and edema
Hot fomentation
Empirical abs till results of C&S
Any pus should be drained

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11
Q

3 criteria of hand abcess drainage

A

Skin incision should be parallel to skin crease never cross it
Incision should be made in a point of maximum tenderness
Midline incision is # in digit instead mid lateral incision

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12
Q

Mention causes of non healing fistula

A

🍑Epithelisation
🍑FB or necrotic tissue.
🍑Ischemia🍑 irradiated tissue
🍑Hypoproteinemia or malnutrition

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13
Q

Mention 4 causes of SIRS

A

Major trauma
Major operation
Major inflammation
Major burn

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14
Q

Class 4 , amount of blood loss ……

A

> 40% >2000ml

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15
Q

Mention 3 compensatory mechanisms during acute hge

A

Increase catecholamines which causes vc of BVs and tachycardia, increase cop
Increase stress hormones
Increase insulin resistance
Increase ADH
Increase respiratory rate

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16
Q

Mention 5 complications of blood transfusion

A

Febrile non hemolytic transfusion reaction
Hemolytic reaction non compatible blood transfusion
Allergic reaction
Transmission of infections HIV, HBV , HCV syphilis
Transfusion related acute lung injury TRALI

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17
Q

Enumerate 4 complications of massive blood transfusion

A

Circulatory overload
Hyperkalemia
Metabolic acidosis
Coagulopathy & DIC

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18
Q

Causes of hypokalemia

A

🌻Severe diarrhea
🌻K losing diuretics
🌻Metabolic alkalosis
🌻Conns syndrome

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19
Q

Mention 4 causes of metabolic acidosis

A

DKA
Lactic acidosis
Chronic renal failure
Salicylate toxicity

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20
Q

Mention 4 causes of metabolic acidosis

A

DKA
Lactic acidosis
Chronic renal failure
Salicylate toxicity

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21
Q

Complications of parenteral nutrition

A

Hyperglycaemia
Hypercholesterolemia
Hyperchloremic metabolic acidosis
Catheter associated sepsis

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22
Q

Complications during insertion of central Iv line

A

Pneumothorax
Air embolism
Cardiac tamponade or perforation
Injury to adjacent artery

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23
Q

Mention 6 types of acquired cysts 🌞

A

🌹Parasitic cyst , hydatid
🌹Implantation dermoid cyst
🌹Retention,Sebaceous cyst
🌹Neoplastic cysis
🌹Traumatic cyst
🌹Exeudation cyst bursa

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24
Q

Postoperative Local wound complications

A

Seroma
Hematoma
Infection SSI
dehiscence or evisceration
Incisional hernia

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25
Q

Causes of postoperative fever

A

Response to surgical trauma
Atelectasis
SSI
RTI , UTI
Anastomotic leak
DVT

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26
Q

Mention types of nutritional support é examples

A

🪷Enteral feeding
1.Sip feeding
2.NGT Rhyl tube
3.Feeding gastrostomy
4.Feeding jejunostomy

🪷Parenteral feeding
1/Central IJV SCV
2/Peripheral
3/ PICC , Peripherally inserted central venous catheter

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27
Q

Mention complications of wound healing

A

🌿Early
Hematoma
Seroma
SSI
EVISCERATION DEHISCENCE
🌿late
Hypertrophic scar
Keloid
Ugly chronic scar
Contracture
Marjolin ulcer
Stitch sinus
Stitch marks

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28
Q

Mention 5 methods of prevention of wound infection

A

🌹The patient
Improving general condition
DM control
ttt of malnutrition
Anemia correction
Ttt of any septic focus
Skin antiseptics
Hair trimming just preoperative
🌹The surgery
Good hemostasis
Avoid hematoma and seroma
Avoid dead space
Appropriate abs
Remove any necrotic tissue or FBs
Shorten post op stay
Delayed primary closure of contaminated wound

🌹==>Proper strelization of surgical instruments

Antibiotics
High concentration in required tissue
No liver or kidney toxicity
Suitable for organism

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29
Q

Discuss 5 complications of massive blood transfusion:

A

A. Hyperkalemia, if blood is old and hemolysis occurs releasing intracellular potassium, may cause cardiac arrhythmia and arrest.

B. Hypocalcemia, due to excess citrate, which is
used as anticoagulant, it binds to the calcium

C. Circulatory overload (heart failure), due to expansion of the intravascular volume.

D. Hypothermia, as the blood is stored at 4 degrees, it may cause coagulopathy and acidosis.

E. Coagulopathy and DIC, as stored blood is deficient
on platelets and coagulation factors

F. Metabolic acidosis, due to the hyperkalemia and hypothermia

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30
Q

Enumerate Factors affecting wound healing ?

A

1) location and vascularity
2) immobilization and shearing forces
3) infection
4) surgical technique
5) presence of fbs or necrotic tissue

31
Q

Types of acute wounds é examples

A

Open wounds
Stab , puncture , cut , incised , abrasion friction burn
Laceration degloving traction avulsion

Closed wounds
Compartment S
Crush S
Contusion , bruises
and hematoma

32
Q

What factors increase the risk of postoperative respiratory complications

A

Smoking
Old age
Obese
Hypoproteinemia
Uper bdominal or thoeacic surger
HF
Chronic steroid use

33
Q

Recommendation for pulmonary t
Risk reduction

A

preoperative
Stop smoking for at leaset 8 wka b4 surgery
Ab prophylaxis and delay surgery if there is chest infection
Education of the patient to do respiratory exercise after surgery
Ttt of any rt obstruction in COPD and asthma

Intraoperative
Limit the time of surgery to less than 3 hrs
Avoid use of pancournium
Use laparoscopic procedure when possible
Use spinal or epidural anesthesia

Postoperative
The patient should do extensive respiratory exercise
CPAP
Use epidural analgesia
Intercosral nerve block

Postoperative

34
Q

Obesity has increase risk of

A

Delayed wound healing
Infection
Regurgitation, difficult intubation
Bed sore
MI DVT
cerebrovascular accident respiratory compromise
Mechanical problems

35
Q

Child mortality risk classification (hepatic pati)

A

Child A 10%
Child B 31%
Child C 76

36
Q

When to postpone elective surgery

A

★Tight MS or AS untill surgically corrected
★SBP>160
DBP>95
★MI in past 6mns
★HF until controlled
★PTA Within 6 wks
★Chronic smoking until patient stops at least 8 wks

37
Q

General post operative complications

A

Post operative fever
Complications of thermal regulation
DVT
cardiovascular
Circulatory collapse
Neurological
Renal
Suprarenal
Thyroid
Pulmonary

38
Q

Mention post operative git complications

A

Paralytic illius,acute gastric dilatation
Gi bleeding
Post operative nausea and vomiting

39
Q

Causes of postoperative gi bleeding

A

Curling ulcer dt stress
Gastritis dt postoperative NSAIDs as analgesia
Mallory wise s dt excessive vomiting
technical errors in anastomotic surgery or stapling

40
Q

RFS OF postoperative nausea and vomiting

A

Female sex
Operation in a young adults
Preoperative vomiting
Motion sickness and migraine
NSAID Postoperative
Poor pain control
Acute gastric dilatation
Paralytic illius

41
Q

Causes of post operative collapse and rapid general deterioration

A

CVS
PE
MI
heart failure
Stroke
Arrhythmia
RESPIRATORY
Failure to reverse anesthesia
Respiratory depression by drugs
Respiratory infection
METABOLIC
Acute adrenal insufficiency
Hypo or huperglycemia
Electrolytes distubance
INFECTION
Sepsis
Septic shock
Ssi
SURGICAL
Slipped ligature
Acute blood loss without compensation
Decompensated dehydration

DRUG REACTION AND ANAPHYLAXIS

42
Q

Causes of postoperative fever

A

In first 2 days
Effect of surgical trauma
Atelectasis
From 3 to 5
Superficial and deep SSI
5th day
UTI Especially è catheter
RTI especially in patients with COPD
Central line infection
The 7th day
Anastomotic leak
Intracavitary collection
Abcesses

43
Q

Causes of postoperative low blood pressure

A

Morphine
Epidural or spinal anaesthesia
MI
Dehydration
Blood loss

44
Q

Components of metabolic response to trauma

A

Neural response
Endocrinal response
Microcirculatory changes
Cellular damage and acute inflammatory response
SIRS early reversible , late irreversible

45
Q

Criteria for SIRS diagnosis

A

Temperature ≥38 or ≤36
Tachycardia>90
Tachypnea>20
Pco2 ≤32 mmhg
Need of mechanical ventilation
Leukocytes ≥12000 or ≤4000
Or band cells >10%

46
Q

Factors that worse SIRS

A

hypovolemia
Hypothermia
Malnutrition
Psychological stress
Pain

47
Q

Explain the pathology of SIRS

A

Initiated by circulation of
🌿Inflammatory cells pnl mq
🌿Cytokines IL 1 ,6, 8, TNF a
🌿Pro inflammatory mediators ( proteases o free radicals, prostaglandins,kinins )
🌿Anti inflammatory mediators (IL 10 ,protease enzymes inhibitors, antioxidants)
🌿Complement
🌿Bacteria and toxins
These mediators cause endothelial dysfunction and widening of capillary pores ,escape OF plasma proteins to interstitial space dragging water after them leading to hypovolemia and systemic hypoperfusion and may cause MOF

48
Q

Define MOF and sequence of individual organ damage

A

Is failure of 2 or more than organs making it difficult to. maintain homeostasis without external support
Sequence
1.Lung
2.Liver
3.Intestine
4.Renal
5.Heart

49
Q

Explain the mechanism of pulmonary failure in MOF

A

As a part of systemic endothelial dysfunction
Pulmonary endothelial cells leak and the alveoli become filled of water this impair ventilation
Opening of pulmonary arteriovenous shunts this cause capillaries hypoperfusion ==>impair perfusion
Interstitial edema ==> impair diffusion

50
Q

📌MRSA is sensitive to
📌VISA is sensitive to

A

📌Vancomycin
Teicoplanin

📌Linezolid
Daptomycin
Tigecycline

51
Q

Infections caused by streptococcus pneumoniae

A

Otitis media
Meningitis
Post splenectomy infection
COPD exacerbation
Bronchopneumonia in susceptible patients

52
Q

Anaerobic streptococcus cause

A

Part of mixed flora present in Intraperitoneal abcess
Areas with necrotic tissue as diabetic leg ulcer

53
Q

Ttt if strept

A

Penicillin is DOC
It is also sensitive to macrolides like erythromycin and claritheromycin
Meningitis
Ceftriaxone and vancomycin

54
Q

The drug that cannot be used in enterococci is

VRE is treated by

A

Cephalosporins
Daptomycin and Linezolid

55
Q

Enterobacteriacea r treated by

A

2&3rd generation cephalosporins,gentamycin and fluroqunolines cipro,levo,moxifloxacin
Cephalosporins resistance ==>carbapenem and amikacin
Carbapenem resistance ==> colistin

56
Q

Psedomonas presents in
It is….. ,% normal commensal

A

Affects debilitated patient
Compound fractures burn catheter

10

57
Q

Psedomonas ttt by

A

Orally effective ttt ciprofloxacin and ofloxacin
Ceftazidim, cefepim carbapenem (piperacillin tazobactam)

58
Q

Causes of necrotizing fasciitis

A

📌After drainage of perianal abcess or ischiorectal abcess
📌After IM or IV injection

59
Q

Ttt of necrotizing fasciitis

A

Prevention
Adequate wound debridement
Ab prophylaxis
Blood transfusion to avoid Ischemia

Curative
Aggressive debridement
Systemic ABs penicillin iv 20-40million u per day+gentamycin
DM control
Fluid nutrition blood transfusion

60
Q

Causative organisms of necrotizing fasciitis

A

Streptococcus
Ecoli
Anaerobic flesh eating bacteria

Associated with fournier gangrene of scrotum
Maleny’s synersism

61
Q

Intestinal barrier is broken by

A

Decrease luminal nutrition of entercytes
Mesenteric ischemia
Altered intestinal flora
This lead to ==>bacterial translocation ==>portal circulation
If Kupffer cells of the liver r impaired
Systemic sepsis==>MOF

62
Q

Predisposing factors of Ssi

A

🌻Patient factors
Debilitating disease
Immunosuppression (chemotherapy, chronic steroid use , DM)
Obesity
Chronic disease
Unfavorable local tissue condition
Presence of septic focus
🌻 Exogenous factors
Type of surgery
Breech of infection control
Improper sterilisation of s equipments
Presence of hematoma or seroma
Presence of dead spce
🌻 surgical factors
Presence of Fbs
Improper surgical technique
Local tissue ischemia and edema

63
Q

Indications of Abs in crean operation

A

Implant (mesh and graft)
Infection will be very severe or life threatening
Patient with valvular heart lesion (IEc)
Emergency surgery

64
Q

Ssi appears bt day ….,….
Earliest manifestion

A

5-10
Wound pain and postoperative fever

65
Q

Ttt of Ludwig’s angina

A

Early massive doses of Abs amoxicillin and metronidazole
Semi setting position
Late submental curved incision of skin and deep fascia

66
Q

Ingrown toenail ttt

A

For mild cases
*The overhanging nail fold is pushed away and reduced in size by daily packing of the lateral groove with antiseptic gauze
*Antibiotic ointment
*Avoid wearing tight shoes
*Warm water salt soaks

Operative
Excision of a wedge including granulation and nail bed
In extensive cases removal of the whole nail with it s bed

67
Q

Pfs of gas gangrene

A

The condition is very common in battle wounds
Muscle wound contaminated by soil feces
High volecity gun shot causing bowel perforation
Associated with amputation contaminated with stool

68
Q

Ttt

A

Plus hyperbaric oxygen for several hours daily
Anti gasgangrene toxin infusion is given

69
Q

The role of neurotoxin of colistridium tetanii

A

Anticholine esterase action interfere è destruction of ach causing generalized tonic regidity of muscles
Convulsion attacks on exposure to minor stimuli

70
Q

Dd of tonic clonic contraction of tetanus
Tonic tetanus trismus meningitis
Clonic hydrophibia of rabies strychnine poisoning

A

Tonic tetanus trismus meningitis
Clonic hydrophibia of rabies strychnine poisoning

71
Q

Complications of streat wound

A

Local
Infection
Tissue indury FT
SCAR كل الانواع

General
Hge hypovolemic shock
ARF
Compartmental s

72
Q

Factors affecting wound healing

A

Local
Ischemia
Immobilization
Irridiation
Infection
Tension
Wound closure method

systemic
Age
Malnutrition
Drugs
Debilitating disease
Chronic diseases
A

73
Q

Ttt of keloid and hypertrophic scar

A

Pressure application
Intralesional steroid
In keloid post operative radiation
Combination of surgery and RT the best

Final Surgery Imp Questions (4 decks)

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